Geospatial epidemiology of hospitalized patients with a positive influenza assay: A nationwide study in Iran, 2016-2018.

INTRODUCTION: Seasonal influenza is a significant public health challenge worldwide. This study aimed to investigate the epidemiological characteristics and spatial patterns of severe hospitalized influenza cases confirmed by polymerase chain reaction (PCR) in Iran. METHODS: Data were obtained from Iran's Ministry of Health and Medical Education and included all hospitalized lab-confirmed influenza cases from January 1, 2016, to December 30, 2018 (n = 9146). The Getis-Ord Gi* and Local Moran's I statistics were used to explore the hotspot areas and spatial cluster/outlier patterns of influenza. We also built a multivariable logistic regression model to identify covariates associated with patients' mortality. RESULTS: Cumulative incidence and mortality rate were estimated at 11.44 and 0.49 (per 100,000), respectively, and case fatality rate was estimated at 4.35%. The patients' median age was 40 (interquartile range: 22-63), and 55.5% (n = 5073) were female. The hotspot and cluster analyses revealed high-risk areas in northern parts of Iran, especially in cold, humid, and densely populated areas. Moreover, influenza hotspots were more common during the colder months of the year, especially in high-elevated regions. Mortality was significantly associated with older age (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI]: 1.01-1.02), infection with virus type-A (aOR: 1.64, 95% CI: 1.27-2.15), male sex (aOR: 1.77, 95% CI: 1.44-2.18), cardiovascular disease (aOR: 1.71, 95% CI: 1.33-2.20), chronic obstructive pulmonary disease (aOR: 1.82, 95% CI: 1.40-2.34), malignancy (aOR: 4.77, 95% CI: 2.87-7.62), and grade-II obesity (aOR: 2.11, 95% CI: 1.09-3.74). CONCLUSIONS: We characterized the spatial and epidemiological heterogeneities of severe hospitalized influenza cases confirmed by PCR in Iran. Detecting influenza hotspot clusters could inform prioritization and geographic specificity of influenza prevention, testing, and mitigation resource management, including vaccination planning in Iran.

Regulatory network analysis of Epstein-Barr virus identifies functional modules and hub genes involved in infectious mononucleosis.

Epstein-Barr virus (EBV) is the most common cause of infectious mononucleosis (IM) and establishes lifetime infection associated with a variety of cancers and autoimmune diseases. The aim of this study was to develop an integrative gene regulatory network (GRN) approach and overlying gene expression data to identify the representative subnetworks for IM and EBV latent infection (LI). After identifying differentially expressed genes (DEGs) in both IM and LI gene expression profiles, functional annotations were applied using gene ontology (GO) and BiNGO tools, and construction of GRNs, topological analysis and identification of modules were carried out using several plugins of Cytoscape. In parallel, a human-EBV GRN was generated using the Hu-Vir database for further analyses. Our analysis revealed that the majority of DEGs in both IM and LI were involved in cell-cycle and DNA repair processes. However, these genes showed a significant negative correlation in the IM and LI states. Furthermore, cyclin-dependent kinase 2 (CDK2) - a hub gene with the highest centrality score - appeared to be the key player in cell cycle regulation in IM disease. The most significant functional modules in the IM and LI states were involved in the regulation of the cell cycle and apoptosis, respectively. Human-EBV network analysis revealed several direct targets of EBV proteins during IM disease. Our study provides an important first report on the response to IM/LI EBV infection in humans. An important aspect of our data was the upregulation of genes associated with cell cycle progression and proliferation.

Progress in measles and rubella elimination in Iran.

BACKGROUND: Measles is a leading cause of death worldwide because of vaccine preventable diseases. Prevention and control of measles and rubella is a high priority for the Islamic Republic of Iran. In 2002, the Ministry of Health and Medical Education in Iran developed a comprehensive strategy to eliminate measles and rubella. This strategy included recommendations for a mass immunization campaign for all persons between the ages of 5-25 years with measles-rubella (MR) vaccine. This report reviews the results of this campaign and progress in the elimination of measles and rubella in Iran. METHODS: Measles vaccination coverage, supplemental immunization activities, surveillance data, and results from a nationwide serosurvey were reviewed. RESULTS: Between 1980 and 2005, vaccination coverage ranged from 38%-99% with sustained high coverage (> or =94-99%) for the past decade. Despite high coverage with the first dose of measles vaccine (MCV1) and the introduction of a second dose of measles in 1984, case counts remained high between 1980 and 2005 with a median case count of 4414. In December 2003, a nationwide immunization campaign was conducted targeting 33,579,082 people between the ages of 5 and 25 years with a combined measles and rubella vaccine; 98% of the target population was vaccinated. A postcampaign serosurvey conducted in 2004 revealed >97.4% of the population aged between 5 and 40 years had immunity to measles and rubella. Case-based surveillance for measles identified 3 children with laboratory confirmed disease in 2004, 35 in 2005, and 42 children in 2006. Most confirmed disease occurred in immigrant communities or communities with migrant populations from neighboring counties with ongoing measles outbreaks. Surveillance for rubella was established after the campaign and identified 37 patients with confirmed disease in the follow-up period. CONCLUSIONS: Implementation of a comprehensive strategy for measles elimination in Iran has remarkably reduced the incidence of measles and rubella to <1 case per 1,000,000. Sporadic transmission continues to occur, particularly in areas with immigrant and nomadic populations.